Massachusetts Medical Society: 2015 Interim Meeting: President's Report

2015 Interim Meeting: President's Report

House of Delegates – Opening Session
Dennis M. Dimitri, M.D., MMS President

For several years, much of our work here at the House has focused on the transformation of the American health care system:

  • The passage of state and federal health care reform … 
  • The adoption of electronic health records and the implementation of Meaningful Use … 
  • The transformation of Medicare … and more

This evolution has continued over the last six months. 

Preparation for the new Medicare payment system have already begun … and the AMA, the MMS and the rest of organized medicine are actively pressing regulators to hit the “pause” button on third stage of Meaningful Use.

These are important trends. But another issue has overshadowed all of these – the epidemic of opioid overdoses in the Commonwealth.

With more than 1,000 overdose-related deaths last year, the depth and breadth of the suffering has propelled this issue to the top of the public agenda.

There have been several public health crises in the recent past –the SARS and Ebola outbreaks, to name just two of them. 

But what makes this public health crisis different from any other is that it cuts across many medical specialties … has engaged more non-medical stakeholders than any other public health issue in memory.

Bereaved families, overwhelmed law enforcement leaders, committed addiction medicine professionals, and many others have made a compelling case that there must be a committed, sustained response to this crisis.

For these reasons and more, the opioid crisis has become Issue #1 this past year … Number One by a long shot.

But as we know, the opioids epidemic is terribly difficult to address, because the relapsing nature of addiction does not yield to simple solutions. 

Furthermore, this is not just an addiction crisis, it’s also a pain medicine issue. In trying to end the overdose epidemic, we cannot forget our patients who suffer from acute or chronic pain every day, and depend on opioid medications to manage it.

The drive to address the overdose crisis has created a highly charged environment, and an earnest campaign to solve a major problem. But in doing so, there is a serious risk that in fighting overdoses, we may again victimize - or even stigmatize - those who seek relief from acute and chronic pain. 

We cannot let this happen!

Physicians know that under-treated pain can be just as insidious as over-treated pain. We’ve embraced the concept that pain is the Fifth Vital Sign – that patients in pain are not well. 

In 2011, an IOM report declared that treating pain properly is a moral imperative, and that undertreated pain is a public health crisis in its own right. 

Unfortunately, in our desire to control pain, physicians unwittingly opened the door to this addiction epidemic. Addressing both of these issues poses a difficult dilemma - how do we treat pain, and yet prevent addiction to the very medications that can ease pain?

This would have largely been a medical debate, if not for the fact that people like Charlie Baker, Maura Healey and many others on the campaign trail last year were repeatedly confronted by the disastrous effects of the opioid epidemic. 

The anguish of mothers and fathers grieving for their lost sons and daughters, left an indelible impression, providing a human element to a story that previously had been told with statistics and charts. 
A medical problem thus became a profound, new moral imperative -  a determined effort to end this crisis.

For the Medical Society, the inflection point came earlier this year when, in a meeting with the Governor, we were challenged to become active partners in this effort. 

We embraced the challenge. Just as law enforcement has taken creative approaches to the crisis, we have done the same.

  • We developed guidelines that challenged physicians to prescribe carefully and conservatively…
  • We opened our entire catalog of pain management CME programs to the public, free of charge ...
  • We facilitated discussions with the medical school deans about coordinating their pain management curricula …
  • We started a sweeping education campaign for the public and for prescribers, in an effort to change behavior …
  • We worked with state government to improve the prescription monitoring program …
  • We joined other health care organizations to advocate for a greater investment in treatment and recovery.

We became not just partners, but bridge builders, fostering dialogue among physicians, elected officials, law enforcement personnel, human services providers, and others. 

The Legislature will not act on the Governor’s legislation until early next year, so in this interlude between legislative terms, it’s useful to think about what the future may hold.

I believe the most difficult question is how success will be defined. How will we know when this concerted effort will have achieved its goals?

Indeed, what are the goals?

Are we seeking changes in prescribing patterns? That’s a useful measure. But it’s an intermediate data point … not the end point.

What about improved and expanded treatment services? Definitely, that’s an important goal – and perhaps the most effective thing that can be done for the long term. But by itself, perhaps not enough.

Should we use overdose deaths as our measure of success? Certainly that’s a critical goal. But because of the long tail of addiction, it may be a long time before we see the curve bending. Using this measure alone, we may not know for years if we’ve succeeded. 

The major risk here is that impatience could give rise to proposals that push the pendulum too far in the other direction - and once again abandon patients who are seeking relief from their acute and chronic pain. 

Regardless of how we define success – and I suspect it will be a combination of these – it must be defined in a collaborative process, with the committed participation of all stakeholders. 

We must have the wisdom to choose the right solutions, the perseverance to stay the course, and never forget those who suffer from pain, as well as those who endure the pain of addiction.
For physicians, there is no more important contribution we can make to ending this crisis.

There is a lot more work to do. Later today, at our first-ever Town Hall meeting, this will be a topic of discussion, along with several other issues of the day. I invite you to join me, Dr. Gessner and Dr. Dorkin here in the auditorium at 5:30, immediately after the Ethics Forum.

I’d like to switch topics for a moment and update you on the search for the Society’s next executive vice president.

As you know, Corinne Broderick has announced that she will retire early next year, after more than 30 years of exemplary service to the Society and to our profession.

Last summer, the Trustees appointed a search committee that reflects the diversity of our entire membership. I chair this committee.

We’ve been working diligently since then to solicit the opinions of members, senior staff and other stakeholders to define the critical issues facing the Medical Society today and tomorrow … and to articulate the qualities we want in our next EVP.

We have developed a list of candidates. The committee has begun to review them, and will invite a selected number of them to come in for in-person interviews.
Our goal is to have the next EVP in place by this coming March.

There will be many occasions over the next few months to thank Corinne for her service, but I don’t want to let this moment pass without expressing gratitude both for myself – and on behalf of the entire membership of this Medical Society.

Corinne, thank you so much for your incredible work!

I have one final point.

You may know that our public education campaign on opioids includes radio advertising during all New England Patriots games. Some of the ads feature Patriots safety Devin McCourty and me.

A few weeks ago, Devin and I participated in a fun event at Winthrop High School, where we talked about the risks of prescription medications, and urged the students to support each other if they get into trouble with addiction.

As part of our campaign, Devin has generously donated a personally autographed football. The MMS Alliance has agreed to sell raffle tickets, in conjunction with its Holiday Boutique, for a chance to be the proud owner of this memorabilia.  

You can purchase tickets outside the auditorium at the Foundation’s display table - $10 each, or three for $20. All proceeds from raffle ticket sales will benefit the MMS and Alliance Charitable Foundation.
First prize is the football autographed by Devin McCourty … second prize is a Patriots coffee mug … and third prize is a Patriots 2016 wall calendar.

We will close the raffle at the end of the Ethics Forum and announce the winners at the special Town Hall Meeting today at 5:30. If the winners are not in attendance at the Town Hall meeting, we will notify them by Monday.

Mr. Speaker, this seems like a good place to conclude my report!

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